2016 School Plot Request Form
School Plots are available to Teachers of public or private school classes PreK-12 and a limited number of adult-education programs. Preference will be given to schools that don’t have their own gardens and that have a successful track record at the farm. Schools will be selected to ensure a diversity of ages and NYC communities are represented. Groups who charge admission fees or program fees for their time on the farm will not be eligible. Please complete this form to apply for plots beginning in April, 1 2016.
SCHOOL INFORMATION
School Name and Number
Your answer
School Address
Your answer
Neighborhood
Your answer
Borough
Your answer
Phone Number
Main telephone number for the school.
Your answer
Enrollment
This refers to the whole school/organization, not for the class(es) you plan to bring.
Your answer
Grades
This refers to the total grade range of the school/organization, not for the class(es) you plan to bring.
Your answer
School Classification
Principal Contact Information
Name
Your answer
Email
Your answer
Phone
Your answer
Parent Coordinator Contact Information
Name
Your answer
Email
Your answer
Phone
Your answer
Sustainability Coordinator Contact Information
Name
Your answer
Email
Your answer
Phone
Your answer
Does your school have a garden?
If you answered yes to the previous question, is your school garden registered with Grow To Learn?
PRIMARY CONTACT
Primary Contact Name
Your answer
Email
Your answer
Phone Number
Your answer
Affiliation/Position
PROGRAM PARTICIPATION INFORMATION
Are you interested in receiving Battery Urban Farm produce in your cafeteria as part of the Garden to School Cafe Program?
How many total students will be coming to the farm during this school year?
Please make your best estimate.
Your answer
How many different classes will be coming to the farm during this school year?
Please make your best estimate.
Your answer
How many total classes will be coming to the farm per week?
Please make your best estimate.
Your answer
How many total students will be coming to the farm per week?
Please make your best estimate.
Your answer
How many hours per week do you plan to be on the farm with students?
Please make your best estimate. Minimum 2 hours.
Your answer
Does your school have existing summer programming that will participate in the School Plots Program?
Teachers wishing to register the plot for use in July and August must be participating in school-sponsored summer programming. Teachers who will not have summer programming but register for the fall, will have their plots maintained by BUF staff during the summer months.
If you answered Yes to the above question, please describe the summer program.
Please describe the type of program and provide the total number of students and hours per week you plan to be on the farm, and subject matter you plan to cover.
Your answer
Please fill out the information below for each class you plan to bring
If you aren't sure, just fill out as much as you know.
CLASS 1
Class 1: What grade level/age is this class?
If 'other' please describe.
Your answer
What area of study is covered in this class?
Check all that apply.
Required
Please briefly describe how your time on the farm will enrich the areas of study you've selected in the above question.
Your answer
CLASS 2
Class 2: What grade level/age is this class?
If 'other' please describe.
Your answer
What area of study is covered in this class?
Check all that apply.
Please briefly describe how your time on the farm will enrich the areas of study you've selected in the above question.
Your answer
CLASS 3
Class 3: What grade level/age is this class?
If 'other' please describe.
Your answer
What area of study is covered in this class?
Check all that apply.
Please briefly describe how your time on the farm will enrich the areas of study you've selected in the above question.
Your answer
CLASS 4
Class 4: What grade level/age is this class?
If 'other' please describe.
Your answer
What area of study is covered in this class?
Check all that apply.
Please briefly describe how your time on the farm will enrich the areas of study you've selected in the above question.
Your answer
CONSENT AND WAIVER FORM
SCHOOL PARTICIPATION BY MINORS

The undersigned confirm that:

(1) We are responsible for obtaining, and have obtained, all necessary permissions from parents/legal guardians for each of the students/the minor children {under 18 years} in the class(es) participating in activities at The Battery Conservancy (TBC) and in Battery Urban Farm (BUF), and
(2) We are responsible for ensuring, and will ensure, the required ratio of chaperones to students.

Furthermore I, on behalf of myself and the students/minor children in my participating class(es), do fully understand and agree the following:

X Neither TBC nor the City of New York will cover any medical expenses due to injury received through participating in BUF. We release and hold harmless the City of New York, Parks & Recreation, TBC, and their respective agents, officers, directors, consultants, and employees from any and all claims for any expenses, personal injury, loss or damages incurred or caused by my students during or in connection with their participation in farming at TBC; provided, that this release does not cover the willful misconduct or gross negligence of TBC.

X That if my student/s find anything hazardous or suspected to be hazardous, he/she shall not touch it, but shall notify TBC/BUF personnel as soon as possible. He/she shall not pick up syringes, broken glass or other sharp materials, or exceptionally large, heavy or unyielding objects and I will instruct my student/s accordingly.

X That any photographs, videotapes, motion pictures or recordings taken of the student(s) in my class(es) may be used for publicity purposes by TBC or for educational/research projects through other institutions or organizations (provided that the child’s full name will not be included unless expressly permitted in writing by parent or legal guardian).

E-Signature
By selecting "I understand and agree" above and entering my name below, I am electronically signing the waiver above. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
Your answer
Photo Permissions: Please do not take photographs of these children
List any students whose parents have not granted photo permission here. It is the teacher's responsibility to point these students out to Battery Urban Farm staff at the start of classes.
Your answer
POLICIES (Page 1 of 2)
(Page 2 of 2)
I understand and agree to the School Plot Program policies.
E-Signature
By selecting "I understand and agree" above and entering my name below, I am electronically signing the School Plot Program policies. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
Your answer
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